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To apply for a job with ECM print out this job application and mail or fax to ECM.

Elelectrical Construction Management, Inc. 11321 Plantside Drive • Louisville, KY 40291 Phone (502) 267-6867 • Fax (502) 267-8750 PLEASE PRINT DATE OF APPLICATION:_______________ LAST NAME:_______________________ FIRST NAME:_______________________ MIDDLE INITIAL:____ SOCIAL SECURITY NUMBER:_______________________ STREET ADDRESS:____________________________________________________ APT#:________________ CITY:______________________ STATE:_______________ ZIP:______________ COUNTY:_______________ PHONE NUMBER: ______________________ ALTERNATE PHONE NUMBER: _______________________ BEST TIME(S) TO CALL: ________________________ E-MAIL ADDRESS: __________________________ TITLE OF JOB APPLIED FOR:_________________________________________________________________ ARE YOU 18 YEARS OF AGE?: YES [ ] OR NO [ ] DATE OF BIRTH IF UNDER 18: ________________ YOUR MINIMUM SALARY REQUIREMENTS ARE: [ ] NEGOTIABLE $__________ PER HOUR / MONTH / YEAR (CIRCLE ONE) DO YOU WANT TO WORK ON A: FULL TIME BASIS [ ] PART TIME REGULAR BASIS [ ] TEMPORARY BASIS [ ] (SPECIFY DAYS AND HOURS BELOW) DAYS AVAILIABLE TO WORK: S M T W TH F S HOURS AVAILABLE TO WORK: ____________________________ DATE AVAILABLE TO WORK: ___________ WHO REFERRED YOU TO EMC: _____________________ ARE YOU A U.S. CITIZEN?: YES [ ] OR NO [ ] IF NOT, DO YOU HAVE A VISA WHICH ALLOWS YOU TO WORK?: YES [ ] OR NO [ ] TYPE OF VISA: ______________________ EXPRIRATION DATE: ______________________ HAVE YOU EVER BEEN CONVICTED FOR ANY VIOLATION OF THE LAW OTHER THAN TRAFFIC RULES : YES [ ] OR NO [ ] IF YES, DESCRIBE THE CIRCUMSTANCES. (NOTE: A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. FACTORS SUCH AS TIME OF THE OFFENSE, REHABILITATION, AND THE SERIOUS NATURE OF THE VIOLATATION WILL BE TAKEN INTO ACCOUNT. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ EDUCATION CIRCLE THE LAST YEAR COMPLETED IN EACH CATEGORY GRADE SCHOOL: 1 2 3 4 5 6 7 8 9 HIGH SCHOOL: 9 10 11 12 DID YOU GRADUATE HIGH SCHOOL: YES [ ] OR NO [ ] HIGH SCHOOL NAME:____________________________ DATES ATENDED: FROM _______ TO _______ COURSE OR MAJOR SUBJECT IF ANY: __________________________________ COLLEGE: 1 2 3 4 5 6 DID YOU GRADUATE COLLEGE: YES [ ] OR NO [ ] COLLEGE NAME:______________________________ DATES ATENDED: FROM ________ TO ________ COURSE OR MAJOR SUBJECT IF ANY: __________________________________ GRADUATE SCHOOL NAME IF ANY:_____________________________________ EMPLOYMENT RECORD BEGIN WITH MOST RECENT POSITION HELD AND LIST IN REVERSE CHRONOLOGICAL ORDER YOUR WORK HISTORY, OR JOBS HELD WITHIN THE LAST 10 YEARS, INCLUDING TEMPORARY JOBS. PLAESE INCLUDE ANY SPECIFIC EXPERIENCE THAT DEMONSTRATES HOW YOU MEET THE MININUM REQUIREMENTS FOR THE POSITION WHICH YOU ARE APPLYING. IF YOU WERE EMPLOYED UNDER A DIFFERENT NAME, GIVE NAME USED. IF NECESSARY, ATTACH ADDITIONAL PAGES. EMPLOYER NAME:_______________________________________________________________________ EMPLOYER ADDRESS: ___________________________________________________________________ SUPERVISER NAME:_____________________________ TITLE: _________________________________ DATES OF EMPLOYMENT: FROM__________ TO__________ SALARY: START_______________ END_______________ DESCRIBE YOUR DUTIES:_________________________________________________________________ _________________________________________________________________________________________ REASON(S) FOR LEAVING:________________________________________________________________ _________________________________________________________________________________________ EMPLOYER NAME:_______________________________________________________________________ EMPLOYER ADDRESS: ___________________________________________________________________ SUPERVISER NAME:_____________________________ TITLE: _________________________________ DATES OF EMPLOYMENT: FROM__________ TO__________ SALARY: START_______________ END_______________ DESCRIBE YOUR DUTIES:_________________________________________________________________ _________________________________________________________________________________________ REASON(S) FOR LEAVING:________________________________________________________________ _________________________________________________________________________________________ EMPLOYER NAME:_______________________________________________________________________ EMPLOYER ADDRESS: ___________________________________________________________________ SUPERVISER NAME:_____________________________ TITLE: _________________________________ DATES OF EMPLOYMENT: FROM__________ TO__________ SALARY: START_______________ END_______________ DESCRIBE YOUR DUTIES:_________________________________________________________________ _________________________________________________________________________________________ REASON(S) FOR LEAVING:________________________________________________________________ _________________________________________________________________________________________ EMPLOYER NAME:_______________________________________________________________________ EMPLOYER ADDRESS: ___________________________________________________________________ SUPERVISER NAME:_____________________________ TITLE: _________________________________ DATES OF EMPLOYMENT: FROM__________ TO__________ SALARY: START_______________ END_______________ DESCRIBE YOUR DUTIES:_________________________________________________________________ _________________________________________________________________________________________ REASON(S) FOR LEAVING:________________________________________________________________ _________________________________________________________________________________________ DO YOU HAVE A VALID DRIVERS LICENSE?: YES [ ] OR NO [ ] IF YES, FROM WHAT STATE: _____________________________________________________________ DO YOU HAVE A VALID COMMERCIAL LICENSE?: YES [ ] OR NO [ ] IF YES, FROM WHAT STATE: _____________________________________________________________ PLEASE INDICATE ANY OTHER SKILLS AND ABILITIES YOU POSSESS, INCLUDING LICENSED OR CERTIFIED MEMBERSHIP IN A PROFFESSION OR TRADE )INDICATE THE TYPE OF LICENSE OR CERTIFICATION, AND ISSUING STATE. _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ IT IS OUR PROCEDURE TO CHECK ALL REFERENCES. IF YOU DO NOT WISH TO HAVE YOUR CURRENT EMPLOYER/SUPERVISOR CONTACTED, PLEASE CHECK THE BOX BELOW. [ ] DO NOT CONTACT MY PRESENT EMPLOYER. COMMENTS:_____________________________________________________________________________ _________________________________________________________________________________________ HAVE YOU EVER APPLIED HERE BEFORE? _______ IF YES, GIVE POSITIONS SOUGHT. _________________________________________________________________________________________ HAVE YOU EVER APPLIED HERE BEFORE? _______ IF YES, GIVE POSITIONS SOUGHT. _________________________________________________________________________________________ HAVE YOU EVER BEEN DISCHARGED, FIRED, OR ASKED TO RESGN FROM ANY POSITION? _______ IF YES, PLEASE EXPLAIN:__________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE LAWS, ECM DOES NOT DISCRIMINATE ON THE BASIS OF AGE, RACE, RELIGION, SEX, SEXUAL ORIENTATION, DISABILITY, NATIONAL OR ETHNIC ORIGIN. OR VETERAN STATUS. I UNDERSTAND THAT OFFICAL JOB OFFERS FROM ECM ARE MADE BY THE EMPLOYMENT OFFICE AND, UNLESS HUMAN RESOURCES INDICATES A DIFFERENT PROCEDURE, OFFERS MADE BY ANYONE ELSE SHOULD BE CONSIDERED UNOFFICIAL AND INVALID. ECM IS A DRUG FREE WORKPLACE. ALL EMPLOYEES WILL BE REQUIRED TO TAKE A DRUG SCREEN TEST PRIOR TO EMPLOYMENT. RANDOM DRUG SCREENING WILL BE REQUESTED DURING EMPLOYMENT AT THE DISCRETION OF THE COMPANY OFFICERS. I HERE BY CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE. I UNDERSTAND THAT, IF EMPLOYED, ALL FALSE STATEMENTS OR OMISSIONS ON THIS APPLICATION ARE GROUNDS FOR IMMEDIATE DISMISSAL. IN PROCESSING THIS EMPLOYMENT APPLICATION, ECM IS AUTHORIZED TO CONTACT AN INVESTIGATION OF MY PERSONAL HISTORY FOR PURPOSES OF DETERMINING MY QUALIFICATIONS FOR EMPLOYMENT. SUCH INVESTIGATION MAY INCLUDE OBTAINING AN INVESTIGATIVE CONSUMER REPORT AND CONTACTING MY PREVIOUS EMPLOYERS AND MY REFERENCES TO GIVE ECM ANY INFORMATION CONCERNING MY PROFESSIONAL COMPETENCE, ETHICS, CHARACTER AND OTHER QUALIFICATIONS FOR EMPLOYMENT.   SIGNATURE:____________________________________________ DATE:____________________________ .